Optimal cutoff value of P2Y12 reaction units to prevent major adverse cardiovascular events in the acute periprocedural period: Post-hoc analysis of the randomized PRASFIT-ACS study. (1st March 2015)

• Record Type: Journal Article
• Authors: Nakamura, Masato; Isshiki, Takaaki; Kimura, Takeshi; Ogawa, Hisao; Yokoi, Hiroyoshi; Nanto, Shinsuke; Takayama, Morimasa; Kitagawa, Kazuo; Ikeda, Yasuo; Saito, Shigeru
• Is Part Of: International journal of cardiology. Volume 182(2015)
• Page Start: 541
• Page End: 548
• Publication Date: 2015-03-01
• Subjects: Prasugrel -- Acute coronary syndrome -- Clopidogrel -- Major adverse cardiovascular event -- Platelet reactivity -- CYP2C19; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.01.026
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Few studies have examined the effects of on-treatment platelet reactivity on the risk of major adverse cardiovascular events (MACE). We aimed to determine the optimal cutoff value of P2Y12 reaction units (PRUs) to prevent MACE occurring within 3 days after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods: We performed post-hoc analyses of 1363 patients enrolled in PRASFIT-ACS, which compared the effects of a prasugrel regimen adjusted for Japanese patients (loading dose/maintenance dose: 20 mg/3.75 mg) with those of clopidogrel (300 mg/75 mg) on MACE and bleeding events for 24–48 weeks after PCI in ACS patients. PRU was serially measured using the VerifyNow® P2Y12 assay and we assessed the relationship between PRU and MACE. Results: Receiver operating characteristic curve analysis showed that PRU ≤ 262 at 5–12 h after ADP receptor antagonist loading was the optimal cutoff value for preventing MACE at up to 3 days after PCI. The incidences of MACE were 5.2% and 10.8% in patients with PRU ≤ 262 or > 262, respectively (odds ratio 0.50, 95% confidence interval 0.25–0.99, p < 0.01). Significantly more prasugrel-treated patients had lower on-treatment platelet reactivity (defined as PRU ≤ 262) compared with clopidogrel-treated patients (79.9% vs. 30.4%, p < 0.0001). Similar differences were observed between the prasugrel and clopidogrel groups for patients with normal or reduced-function CYP2C19 alleles. Conclusions: The optimal PRU cutoff value for preventing MACE was 262 in Japanese ACS patients. Prasugrel rapidly reduced PRU with a large proportion of patients having low on-treatment platelet reactivity. Highlights: Platelet reactivity cutoffs may predict major adverse cardiovascular events (MACE). We assessed P2Y12 reaction unit (PRU) cutoff values in PRASFIT-ACS. MACE occurred in 5.2% and 10.8% in patients with PRU ≤ 262 or > 262, respectively. The risk of MACE was lower in patients with PRU ≤ 262 at 3 days after PCI. More prasugrel-treated patients than clopidogrel-treated patients had PRU ≤ 262.